Answers

Q: WHAT ARE COMMON CAUSES OF BACK PAIN?
A: Muscle or ligament sprain/strain and facet joint sprain due to minor injury or postural stress is the most common cause of spinal pain. Fortunately, most episodes of spinal sprain/strain are uncomplicated requiring only minimal therapy. However, more complex conditions cause spinal pain including from herniated discs, spondylolisthesis, failed back surgery and whiplash. These conditions require a more comprehensive clinical management strategy. For the over 60 age group degenerative changes in the discs and joints of the spine are often a source of pain potentially leading to spinal stenosis. Bone demineralization and fractures (osteoporosis) as well as spinal muscle de-conditioning are other common sources of pain.

Q: WHAT IS THE DIFFERENCE BETWEEN A HERNIATED DISC AND A BULGING DISC?
A: A disc bulge may occur from disc settling that occurs with degenerative changes, or it can be related to thinning of the outer fibers of the disc, allowing the nucleus of the disc to “bulge”. A herniation occurs when the annulus fibers tear and the nucleus of the disc protrudes or leaks into the spinal canal or intervertebral foramen.
When the disc bulges or herniates, the torn ligament in the outer part of the disc can be a source of severe back pain – just like tearing a ligament in your ankle. The jellylike material inside the disc (nucleus) is forced out through the tiny tears or cracks in the annulus, which causes the disc to bulge, break open (rupture) or break into fragments. If the disc material herniates and seeps through the annulus, it can compress or irritate the delicate nerves as they pass by through the vertebral facets and cause pain and neurological deficits.

Q: ARE BULGING OR HERNIATED DISCS NORMAL?
A: As changes in the disc occur, it loses water content and becomes thinner. Degeneration of the spinal disc may be associated with a bulge in the annulus. Bulging discs are typically asymptomatic. The majority of people over age 40 have disc bulging even if they do not have any pain. Disc herniations are typically associated with degenerative changes but can also occur without causing symptoms. These are usually smaller herniations without significant nerve or spinal cord compression.

Q: HOW DID I HERNIATE MY DISC?
A: Most spinal disc herniations are caused by an injury, with some element of weight bearing (loading) in conjunction with a forward bending and twisting maneuver of the spine. Some patients do not recall any one incident which may have torn their disc. In most cases, it is probable that an inherent weakness or small tears in the annulus of the disc may lead to the herniation over a longer period of time.

Q: WHAT ARE THE SYMPTOMS OF A HERNIATED DISC?
A: A disc herniation large enough to compress a spinal nerve root in the lumbar spine typically causes radiating leg pain through the buttock, thigh, leg and often into the foot. Numbness, tingling, and leg weakness may be common. Neurological tests may be positive for reduced reflexes and muscle strength. Many people with disc herniations do not have any symptoms, or they had minor back or leg pain but it went away over time.

Common Symptoms of Herniated Cervical

Arm muscle weakness

Deep pain near or over the shoulder blades on the affected side

Increased pain when bending the neck or turning head to the side

Neck pain, especially in the back and sides

Pain made worse with coughing, straining, or laughing

Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest

Spasm of the neck muscles

Common Symptoms of Herniated Lumbar Discs

Muscle spasm

Muscle weakness or atrophy

Pain made worse with coughing, straining, or laughing

Pain radiating to the buttocks, legs, and feet

Low back pain

Tingling or numbness in legs or feet

Q: WHAT IS DEGENERATIVE DISC DISEASE?
A: A degenerative disc loses its normal water content and nutrients and hence experiences cellular death. This results in the disc’s decreased ability to serve as a compressible cushion between the vertebrae and instability in the spinal segment. Over time, the spine becomes stiffer due to changes in the vertebral body such as osteophyte formation, ligament rigidity and bony fusion of the joint.

Q: WHAT IS LUMBAR INSTABILITY?
A: Lumbar instability occurs when the spine loses its ability to maintain its vertebrae in normal alignment due to degenerative disc disease or fracture (spondylolisthesis). Instability causes pain from abnormally stressed facet joints and compressed or irritated nerve roots.

Q: WHAT IS SPINAL STENOSIS?
A: Any narrowing of the area normally occupied by nerves in the spine is called stenosis. Central stenosis occurs in the middle of the spinal canal, and foraminal stenosis occurs where the nerve roots exit the spine. Spinal stenosis is commonly caused by bone spurring (due to osteoarthritis), ligament rigidity or disc herniations and less commonly by spinal tumors, Paget’s disease and spinal dislocation/instability.

Q: HOW DOES THE INTERVERTEBRAL DISC STAY HEALTHY?
A: The disc is virtually an avascular structure (does not receive direct blood supply) with the exception of the peripheral ends. Under normal conditions the disc receives nutrients and fluid by a process known as imbibition through the vertebral end plates. This process relies on normal compressive forces on the spine and periods of rest and decompression. During the day, your body weight and other loads compress the discs, causing a loss of water and an increase in electrolyte concentration within the nucleus. At night, when you are lying down and the pressure is off the discs, the discs are rapidly rehydrated by diffusion. Your spine benefits from the cycle of activity during the day and rest during sleep at night and is capable of considerable regeneration through this natural process of imbibition.

Q: WHAT IS SPINAL DECOMPRESSION AND HOW IS IT DIFFERENT FROM TRACTION?
A: Spinal decompression can be described as a progressive therapeutic stabilization system for the spine. Although spinal decompression may be used as a stand-alone intervention for selected cases of back pain, it is typically used in conjunction with other effective therapeutic interventions at Spinegroup. Manual and mechanical static traction have been used for years to treat musculoskeletal pain. Although traction is effective for some causes of spinal pain, the linear and static forces exerted on the spine often resulted in muscle spasms and worsening the condition. Spinal Decompression which is the new generation of intermittent traction devices provides the innovation needed to mimic the intricate nuances of the manual therapist’s hands resulting in a safe, comfortable, and fluid motion of unloading.

Q: WHAT ARE THE CLINICAL BENEFITS OF SPINAL DECOMPRESSION AND HOW DOES IT WORK?
A: The clinical benefits of spinal decompression include unloading of the spinal segments to relieve pressure off nerve roots, mobili-zation,stretching of ligaments and tendons, decrease in muscle tone, increase in flexibility and increased blood flow and circulation. Its clinical benefit to the intervertebral disc is what makes spinal decompression unique. Unlike traditional traction, spinal decompression has the ability to mimic the natural process of imbibition- the process by which the disc receives nutrients and hydration. The mechanical action of pumping the disc at set intervals, allows your disc to absorb more water and nutrients and enable regeneration of cells and repair – increasing the thickness of the disc. There is limited clinical evidence that the negative pressure created by spinal decompression draws up herniated material which may interfere or irritate nerve roots. Negative pressures produced by spinal decompression have been measured to drop as low as -160 mmHG within the injured disc during the treatment session. This is compared to normal discal pressures of 100 mmHG while standing up right or 75 mmHg while sleeping during the night. Spinal decompression may also aid in strengthening the outer ligaments (annulus) which help to hold the nuclear material in place while enabling the disc to absorb more fluid and nutrients.

Q: IS SPINAL DECOMPRESSION EFFECTIVE AND SAFE FOR ALL CAUSES OF BACK PAIN?
A: No. In fact, there are several contra-indications for spinal decompression. The use of spinal decompression therapy for back and neck pain due to fractures, osteoporosis, spondylolisthesis, joint instability, post surgical fusion (with instrumentation), spinal infections, tumours, malignancies or aneurysms is not recommended due to adverse risks and harmful consequences. It is always important that you receive a proper diagnosis prior to any treatment to ensure you are prescribed safe and effective care.

Q: IS THE USE OF INHALED OXYGEN A SAFE THERAPY FOR SPINAL PAIN?
A: Oxygen therapy can be life-saving. However, oxygen is a drug and therefore should only be used when clinically indicated because it can have irreversible adverse effects. In fact, there are numerous side effects of unnecessary use of oxygen on lung tissue, eyes and brain.
Some potential negative effects on the central nervous system are:

muscle twitching and spasm

nausea and vomiting

dizziness

vision (tunnel vision) and hearing difficulties (tinnitus)

twitching of facial muscles

irritability, confusion and a sense of impending doom

trouble breathing, anxiety

unusual fatigue

incoordination

convulsion

Nonetheless, there is limited evidence that conservative low-flow oxygen therapy may be beneficial for some selected cases of migraine headaches. However, the research currently does not support the use of oxygen or ozone therapy for spinal pain as the adverse effects outweigh any potential positive outcomes.

Q: WHAT ARE THE THERAPEUTIC BENEFITS OF LASER THERAPY?
A: “LASER” is an acronym that stands for Light Amplification by Stimulated Emission or Radiation. In simple terms this refers to light waves of a specific wavelength – both artificial and sunlight usually consist of many different wavelengths of light scattering in all different directions. The clinical effects of LASER are numerous, including pain management, improved nerve function, inflammation reduction, faster wound healing (open wounds and burns), accelerated tendon, ligament and muscle healing, improved blood flow, increased cellular metabolic activity (particularly of blood cells), reduced formation of scar tissue, enhanced immune function.

Q: IS THERE RESEARCH TO SUPPORT WELLNESS CARE?
A: Wellness Care is not aromatherapy, reflexology or inappropriate use of spinal manipulation. From an evidence standpoint, Wellness Care is a comprehensive management strategy which addresses the physical, psychological and social factors impacting the patient with the goal of active care. Research indicates that wellness care is core to the prevention and management of all chronic illness including cases of spinal disorders.

Q: WHAT IS PROLOTHERAPY AND HOW DOES IT WORK?
A: Prolotherapy is a method of injection treatment to stimulate healing. Commonly a solution of dextrose or saline is injected to ligaments and connective tissue initiating an injury response, and activating the inflammatory cascade. The inflammatory process initiates a rise in growth factor levels and provides the prime conditions to promote tissue repair or growth. Prolotherapy is not effective for all sources of back pain but may be beneficial for chronic pain caused by laxity of the spinal ligaments and some overuse or traumatic ligament injuries of the extremities.

Q: IS PROLOTHERAPY THE ONLY METHOD TO STRENGTHEN LIGAMENTS AND CONNECTIVE TISSUE?
A: No. While prolotherapy is the most invasive of the conservative approaches, it is certainly not the only method used to promote tissue proliferation or the most researched. The spinal disc and all ligaments are by and large avascular, meaning they do not receive blood supply which would normally assist in healing. They do, however, have the natural ability to repair itself through cell proliferation through physical and chemical stimulation. Many other approaches including acupuncture, laser therapy and mechanical stretching have been shown to increase the tensile strength and proliferation of ligaments and fibrous connective tissue, through loading, unloading, increased cellular metabolic activity and direct irritation.

Q: WHAT IS RADIAL SHOCKWAVE THERAPY AND WHAT ARE THE BENEFITS?

A: The primary effect of these shockwaves is a direct mechanical force that occurs at a cellular level as the wave’s energy passes through tissue. These waves cause a controlled impact on the tissue being treated. The result is a biological reaction within the cells of that tissue which causes an increase in blood circulation through the injured site, and triggers the body to accelerate its natural healing processes. Radial shockwave treatments increase the metabolic activity around the site of pain or discomfort. It stimulates the re-absorption of irritating calcium deposits in tendons, accelerates the body’s natural healing process, and reduces pain.

Research indicates that the mechanical stimulation produced by Shockwaves is capable of inducing positive reactive processes in the cellular structure of injured tissue. Radial Shockwave Therapy works without the need for drugs, stimulates the body’s natural ability to heal itself, and in some cases can even help eliminate the need for invasive surgery. Radial Shockwave Therapy can be used to effectively treat;